WebSep 1, 2024 · This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s Federal brochures (Standard Option and Basic Option: RI 71-005; FEP Blue Focus: RI 71-017). All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochures. WebAuthorized Representative Designation Form. Use this form to select an individual or entity to act on your behalf during the disputed claims process. You can find detailed instructions on how to file an appeal in the Disputed Claims Process document. English.
Claim Forms - Blue Cross and Blue Shield
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